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Brain & Heart Digital tools for stroke and bleeding risk in AF

Based on the complexity of input variables and on the CHA DS -VASc score. While many predictive risk
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outputs, three out of the five tools are physician-facing; scores have their own calculators accessible through both
the CardioSmart Atrial Fibrillation and Bleeding Risk web and mobile applications, digital tools differ in design
Calculator are patient-facing; and the Mayo Clinic by including interactive elements that extend calculations
Anticoagulation Choice Decision Aid is both patient- and with details not present in the original output of the score.
physician-facing. Two of the five tools provide information Digital tools are not designed to improve the predictability
about when the tool was last updated, either with new of a risk score but to increase their understandability and
information or any indication of further maintenance accessibility. This includes contextualization through
being done. Four out of the five tools include instructions organizing the output in statistical measures to improve
on what the digital tool and calculator are for on a user the meaning of results, including graphical representations
input page (Table A1). of outputs in both web format and exportable format
With regard to the outcomes predicted, all digital for communication, improving interactivity with inputs
tools, except for the CardioSmart Atrial Fibrillation and and outputs by providing point of access explanation
Bleeding Risk Calculator, provided distinct risk estimates of the variables involved in the score and explanation of
for the scenarios of no intervention compared with the results, and aggregation of evidence and influencing
any possible pharmacological intervention but did not information on the predictive risk scores over which these
distinguish between specific drugs (Table 4). The ACC tools function. SPARCtool features dynamic bar graphs
AnticoagEvaluator provides distinct risk estimates for the to visualize risks, while the Mayo Clinic Anticoagulation
use of no therapy, aspirin, aspirin + clopidogrel, apixaban, Choice Decision Aid uses risk pyramids to picture this.
dabigatran, edoxaban, rivaroxaban, and warfarin. The As explored in the subsequent sections, digital tools also
greatest diversity of medications and associated risks was aid in reducing the complexity of output to a form that
presented by the SPARCtool, which provides distinct is far more easily understood by patients, best illustrated
risk estimates for the use of no therapy, aspirin, aspirin by the Mayo Clinic Anticoagulation Choice Decision Aid
+ clopidogrel, warfarin, dabigatran 110 mg, dabigatran and the CardioSmart Atrial Fibrillation and Bleeding Risk
150 mg, rivaroxaban, apixaban, edoxaban 30 mg, and Calculator. In summary, a digital tool is not only an output
edoxaban 60 mg. Meanwhile, the CardioSmart Atrial for the predictive risk score but a means to enrich findings
Fibrillation and Bleeding Risk Calculator, which is patient- beyond solely the risk predicted to broaden understanding
facing, presents the risk of stroke in a categorization of and ease accessibility for patients and providers.
low, moderate, high, and very high, with no numerical
presentation of these variables. 7. Features of currently available digital
tools
With regard to governance information for each of these
digital tools, all five tools include a medical disclaimer, an The digital tools presented in this review are notable for
accessible privacy policy on the digital tool interface, and several features that improve ease of use and understanding.
terms and conditions (Table A2). Only the GARFIELD-AF These features should be considered for incorporation in
Risk Calculator has a “frequently asked questions” section the future development of similar applications.
related to understanding the tool and its findings. Both 7.1. Ability to export results for patient education
the GARFIELD-AF Risk Calculator and the Mayo Clinic
Anticoagulation Choice Decision Aid also include a The Mayo Clinic Anticoagulation Choice Decision Aid
feedback section where users can suggest improvements to offers users the capability to export a specific document
the web application or its exportable materials. that summarizes the results of their assessment. This
document explains the implications of the output regarding
6.3. Distinguishing between risk scores and digital the patients’ risk of developing stroke, and it outlines
tools of risk scores how this risk is mitigated or augmented by the decision
All the calculators evaluated in this review source their to pursue no anticoagulation, or anticoagulation using
recommendations from validated predictive risk scores warfarin, or a direct oral anticoagulant. Similarly, the ACC
but additionally provide the ability to combine findings, AnticoagEvaluator application provides an option to email
present findings, and export findings for provider and results in a concise text statement along with a graphical
patient decision-making. Almost all digital tools that were representation of stroke and bleeding risk estimation.
evaluated for this review, except for the GARFIELD-AF This accessibility enables patients to be well-informed
calculator and the CardioSmart Atrial Fibrillation and and facilitates the easy sharing of information with family
Bleeding Risk calculator, explicitly state that they are based members involved in their care.

Volume 2 Issue 3 (2024) 13 doi: 10.36922/bh.3068